Lodge de Guyon syndrome

The Loge-de-Guyon syndrome is a nerve constriction syndrome affecting the distal part of the ulnar nerve (elbow nerve), hence the synonym “syndrome of the distal ulnar nerve”. This is because the ulnar nerve can also be damaged further up the elbow, in the ulnar sulcus. The Guyon’s Lodge is an anatomical bottleneck in the area of the wrist through which the ulnar artery (elbow artery) runs in addition to the ulnar nerve.

Like the carpal tunnel, the Guyon Loge is limited by bony and connective tissue structures. These include the pea bone (Os pisiforme), the hooked process of the hooked leg (Hamulus ossis hamati) and the retinaculum flexorum. The Retinaculum flexorum simultaneously limits the Loge de Guyon dorsally (bottom) and the carpal tunnel ventrally (top).

Loge de Guyon syndrome can occur after a fracture of the wrist or through maximum extension of the wrist, which then compresses the elbow nerve as it passes through the Guyon loge. In addition, space-occupying processes can occur in the Loge de Guyon as a result of a ganglion (overlying leg). The ganglion is a tumourous tissue change that is very typical for this site and forms on joint capsules or tendon sheaths.

In addition, mechanical overstrain, such as long cycling or regular manual work with the ball of the little finger, is a risk factor for Loge de Guyon syndrome. The N. ulnaris splits into 2 branches during its course through the Guyon Loge: a superficial branch (ramus superficialis) and a deep branch (ramus profundus). The ramus profundus, which is responsible for the motor innervation of the muscles, is much more frequently affected by entrapment than the superficial branch, which contains the sensitive parts.

For this reason, the focus is more on motor deficits. These manifest themselves in the impairment of thumb adduction, so that fine motor skills and writing cause problems. In addition, paresthesia (sensory deficiencies) with tingling and numbness occurs in the area supplied by the ulnar nerve, i.e. in the little finger and parts of the ring finger.

The symptoms of Loge-de-Guyon syndrome are classified according to their severity in the Gross and Gelbermann classification. In its early stages, Loge de Guyon syndrome is a largely reversible nerve compression syndrome. Before surgery is indicated, conservative therapy is often sufficient.

However, the choice of therapy also depends on the cause. A Loge-de-Guyon syndrome caused by mechanical overstrain can first be treated with a conservative method. This is done in the sense of relieving and avoiding the heavy and regular strain, since the nerve can regenerate relatively quickly.